Papers by mostafa mokhtari
In the premature infant, somatosensory and visual stimuli trigger an immature electroencephalogra... more In the premature infant, somatosensory and visual stimuli trigger an immature electroencephalographic (EEG) pattern, ‘‘delta-brushes,’ ’ in the corresponding sensory cortical areas. Whether auditory stimuli evoke delta-brushes in the premature auditory cortex has not been reported. Here, responses to auditory stimuli were studied in 46 premature infants without neurologic risk aged 31 to 38 postmenstrual weeks (PMW) during routine EEG recording. Stimuli consisted of either low-volume technogenic ‘‘clicks’ ’ near the background noise level of the neonatal care unit, or a human voice at conversational sound level. Stimuli were administrated pseudo-randomly during quiet and active sleep. In another protocol, the cortical response to a composite stimulus (‘‘click’ ’ and voice) was manually triggered during EEG hypoactive periods of quiet sleep. Cortical responses were analyzed by event detection, power frequency analysis and stimulus locked averaging. Before 34 PMW, both voice and ‘‘cli...
Le processus decisionnel est un evenement particulier qui confronte les soignants a leurs doutes ... more Le processus decisionnel est un evenement particulier qui confronte les soignants a leurs doutes et a leurs incertitudes. Chaque decision comporte ineluctablement une part de doute et d’incertitude, sinon elle ne merite pas d’etre appelee « decision », car elle ne serait que le resultat de l’application d’un savoir acquis a l’avance, a une situation connue. C’est cette part d’incertitude qui est le lieu de la reflexion et qui offre a chacun la possibilite de se questionner, c’est-a-dire de se mettre dans la situation ou il faut vaincre l’indecidable pour pouvoir decider. Au cours de ce travail, j’aborde le role du medecin en tant qu’arbitre entre le certain et l’incertain en situation de fin de vie chez le nouveau-ne. Afin de cerner cette problematique, je rapporte six observations cliniques, toutes tirees de ma propre experience et qui illustrent mieux qu’un long discours les notions du certain et de l’incertain, et permettent de donner a chacune de ces notions son veritable sens p...
Frontiers in Pediatrics, 2021
Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation f... more Objectives: To evaluate the positive threshold of PCT for neonates of <32 weeks of gestation for the diagnosis of early-onset sepsis and to determine if the level of PCT collected within 6 h of life could be used. Design: Retrospective and bicentric study from May 2016 to April 2018. Setting: Two groups were established, neonates evaluated for PCT at birth (CordPCT) and within 6 h of life (delPCT). Patients: Two hundred and sixty neonates of <32 weeks of gestation born in Nice and South Paris (Bicêtre) University Hospitals, had been evaluated for PCT level. Main Outcomes Measures: The value of the PCT positive threshold was determined for the total population and each groups thanks ROC curves. Results: The threshold level of PCT for the total population was 0.98 ng/mL. The threshold value of cordPCT group was 1.00 vs. 0.98 ng/mL for delPCT group. The area under the Receiver Operating Characteristics curve for PCT sampled in delPCT group was significantly higher than in cordPCT...
BACKGROUND Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference cat... more BACKGROUND Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). METHODS Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. RESULTS Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0-110 days), median weight was 1700 g (range: 605-4960 g) at insertion. In most cases, ...
... Cependant, là aussi des recommandations publiées par le Groupe francophone de réanimation et ... more ... Cependant, là aussi des recommandations publiées par le Groupe francophone de réanimation et urgences pédiatriques (GFRUP) proposent une participation plus large des parents dans ces prises de décision, tout en insistant sur la prudence à garder : «
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Aim: This is the first French preliminary study to evaluate the psychological health of parents w... more Aim: This is the first French preliminary study to evaluate the psychological health of parents with infants treated by therapeutic hypothermia for anoxo-ischemic encephalopathy and discharged from the hospital with regular initial progression (MRI and normal outpatient examinations).Materials and method: Seven children, under age two, treated with therapeutic hypothermia for anoxo-ischemic encephalopathy at birth and their parents were met and examined. All the children were discharged from the maternity ward with a normal MRI and a satisfactory clinical examination. The Brunet-Lezine scale was used to measure the children’s psychomotor development, while the parents’ psychological health was evaluated using two adapted scales – the Edinburgh Postnatal Depression Scale and the Perinatal Post-Traumatic Stress Disorder scale – in addition to a semi-structured interview.Results: With the revised Brunet-Lezine scale, the children did not present significant developmental delay (DQ between 98 and 97). However, eight to eighteen months after the event, 50 % of mothers and 25 % of fathers showed pathological scores of post-traumatic stress. The other half of the mothers and 25 % of fathers showed postnatal depression. Interviews uncovered traumatic experiences of delivery; bonding difficulties for the first minutes and days following childbirth; high exposure of fathers; extreme projections about life and death during the hypothermia treatment; and the importance of MRI results and the stay in kangaroo care for reassurance and growing accustomed to the feeling of parenthood. We also found persistent parental concerns six months to one year later despite the absence of disability for their children.Conclusion: Anoxo-ischemic encephalopathy and therapeutic hypothermia are psychological stressors for parents, even in the absence of complications. This study confirms the need for a trusted therapeutic framework during hospitalization. But it also shows the importance of a preventive multidisciplinary follow-up for all families, regardless of the medical outcome. More research is needed to better understand and help families facing these life experiences.
Revue de Médecine Périnatale
On ne retrouve dans la litterature que quelques evaluations et de solidite diverse des pratiques ... more On ne retrouve dans la litterature que quelques evaluations et de solidite diverse des pratiques entourant la prise en charge du nouveau-ne a terme bien portant en salle de naissance, tels les effets deleteres de l'aspiration nasopharyngee et gastrique systematique ou le benefice sur l'allaitement du peau a peau precoce et du clampage retarde du cordon dur, le risque d'anemie dans la premiere annee de vie ou encore l'absence d'effet deletere du bain precoce sauf sur le taux d'allaitement maternel. Plusieurs etudes retrouvent l'inutilite d'un collyre systematique et des soins de cordon avec antiseptique en cas de naissance a l'hopital ou de bon niveau d'hygiene. De plus, si l'interet de la vitamine K est demontre, la voie d'administration dans la prevention de la forme tardive n'est toujours pas tranchee. Toutefois, il est important de noter que, malgre le faible niveau de preuve souvent rencontre dans les etudes, toutes ces evaluations vont dans le meme sens, celui d'abandonner progressivement les pratiques systematiques au profit de pratiques individuelles adaptees a l'etat de l'enfant et au contexte de sa naissance.
Prenatal Diagnosis
To evaluate neonatal mortality and morbidity up to 6 months in neonates with congenital diaphragm... more To evaluate neonatal mortality and morbidity up to 6 months in neonates with congenital diaphragmatic hernia (CDH) with or without a hernia sac.
The Journal of Pediatrics
Objectives To assess whether it is possible to identify the neonatal predictors of neonatal hyper... more Objectives To assess whether it is possible to identify the neonatal predictors of neonatal hyperthyroidism at the presymptomatic stage of the disease. Study design This retrospective multicenter study in 10 maternity units was based on the medical records of all patients monitored for a pregnancy between January 1, 2007, and January 1, 2014. Among 280 000 births, 2288 medical records of women with thyroid dysfunction were selected and screened. Of these, 415 women had Graves disease and were positive for thyrotropin receptor antibody during pregnancy, and were included. Results A thyroid‐stimulating hormone (TSH) level of less than 0.90 mIU/L between days 3 and 7 of life predicted neonatal hyperthyroidism with a sensitivity 78% (95% CI, 74%‐82%) and a and specificity of 99% (95% CI, 98%‐100%), a positive predictive value of 90% (95% CI, 87%‐93%), a negative predictive value of 98% (95% CI, 97%‐99%), and an area under the receiver operating characteristic curve of 0.99 (95% CI, 0.97‐1.0). A thyrotropin receptor antibody (TRAb) elimination time was calculated using the equation: 7.28 + 2.88 × log() + 11.62 log(TRAb2). Conclusions All newborns with a TSH level of less than 0.90 mIU/L should be examined by a pediatrician. Using TSH, it is possible to screen for neonatal hypothyroidism and for neonatal hyperthyroidism with a TSH cutoff of 0.90 mIU/L, and this shows the relevance of our study in terms of public health.
Transfusion, Jan 22, 2017
Red blood cell (RBC) Thomsen-Friedenreich antigen exposure (T activation) in infants with necroti... more Red blood cell (RBC) Thomsen-Friedenreich antigen exposure (T activation) in infants with necrotizing enterocolitis (NEC) has occasionally been associated with posttransfusional intravascular hemolysis thought to be due to anti-T antibodies in the donor plasma. We describe an infant with NEC and Clostridium perfringens infection complicated by severe hemolysis after plasma transfusion. After this case, infants with confirmed NEC were prospectively evaluated for T activation. We checked for hemolysis in patients with T activation receiving plasma-containing blood products. The infant had received 80 mL of fresh-frozen plasma (FFP). His RBCs displayed strong T activation, and agglutination was observed with four of six ABO-compatible FFP units. A direct antiglobulin test was negative. IgM-class anti-T antibodies were present in small amounts (titer of 8) in the transfused FFP. Anti-T antibodies from the blood donor were not hemolytic in vitro. In the prospective study, T activation wa...
Annals of intensive care, 2017
Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most cha... more Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown. This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH. During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thorac...
Pediatric Critical Care Medicine, 2017
Objectives: Central venous access in critically ill, small infants remains technically challengin... more Objectives: Central venous access in critically ill, small infants remains technically challenging even in experienced hands. Several vascular accesses exist, but the subclavian vein is often preferred for central venous catheter insertion in infants where abdominal malformation and/or closure of the vein preclude the use of umbilical venous catheters, as catheterization of the subclavian vein is easier in very short necks than the internal jugular vein for age-related anatomical reasons. The subclavian vein approach is yet relatively undescribed in low birth weight infants (i.e., < 2,500 g), and this study aims to explore the feasibility of this technique in very small infants. Design: Retrospective data collection of prospectively registered data on central venous catheter insertion in infants. Setting: Neonatal ICU and PICU at a university hospital. Patients: One hundred and five newborn children hospitalized in at the ICU. Interventions: An ultrasound-guided supraclavicular approach was applied on all infants who had an subclavian vein catheterization during a 30-month period from January 2013 to July 2015. Measurements and Main Results: One hundred seven supraclavicular subclavian vein catheters were placed in 105 children weighing less than 5,000 g. Among those, 40 patients weighed less than 2,500 g and 10 patients weighed less than 1,500 g. Successful central venous catheter insertion, defined as the correct placement of a functional double-lumen catheter (3F or 4F), was obtained in 97.3%. All three registered failed attempts were due to hematomas from venous bleeding and occurred in infants weighing greater than 2,500 g. No case of accidental arterial puncture or pleural puncture was registered. Conclusions: This large series of subclavian vein catheterizations in small infants demonstrates the feasibility of subclavian vein catheterizations even in very small neonates weighing less than 1,500 g.
Quarterly Journal of New Thoughts on Education, Feb 15, 2015
PLOS ONE, 2016
Rationale Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respirator... more Rationale Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown. Objective We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission. Methods Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database. Results Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor's visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.
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Papers by mostafa mokhtari